Article Abstract

Risk factor analysis and management strategies of operating room-related infections after coronary artery bypass grafting

Authors: Lifen Pan, Shufang Tan, Linlan Cao, Xiaoling Feng

Abstract

Background: To investigate and analyze the risk factors of operating room-related infections after coronary artery bypass grafting (CABG), to propose corresponding infection control management strategies, and to verify and evaluate the effectiveness of the strategy implementation.
Methods: Patients with coronary heart disease who underwent CABG in a hospital from January 2015 to December 2016 were selected for inclusion in this study. The following patient variables were documented: demographics, history of underlying diseases (hypertension and diabetes), preoperative American Society of Anesthesiologists (ASA) score, skin preparation method, perioperative use of antibiotics, operation duration, intraoperative hypothermia, intraoperative blood loss, intraoperative blood transfusion, presence of visitors in the operating room, consecutive use of the same operating room, qualification of the surgeon, and surgical site infection. The infection diagnosis was confirmed using the Diagnostic Criteria for Nosocomial Infections (Trial) issued by the Ministry of Health in 2001. Univariate chi-square tests and multivariate logistic regression analysis were used to analyze the risk factors for infection in patients undergoing CABG, and infection control management strategies were proposed. The proposed infection control strategies were applied to patients who underwent CABG in the hospital in 2017. The effectiveness of the strategy implementation was evaluated.
Results: We analyzed in 139 patients (417 coronary artery bypass grafts from January 2015 to December 2016) and identified 4 surgical site infections. The incidence of infection was 2.88%. According to the univariate analysis, the following factors were related to the high incidence of surgical site infections: advanced age, history of underlying diseases (hypertension and diabetes), obesity, ASA score (class II or above), conventional skin preparation method, irrational perioperative antibiotic use, operation duration >4 hours, presence of visitors in the operating room, and consecutive use of the same operating room (P<0.05 for all variables). Multivariate logistic regression analysis showed that advanced age, history of underlying diseases (hypertension and diabetes), irrational perioperative antibiotic use, operation duration >4 hours, and presence of visitors in the operating room were high risk factors for surgical site infection after CABG. From January 2017 to December 2017, after applying the proposed infection control measures to patients undergoing CABG, the surgical site infection rate was 1.13% (3/266), which was significantly different from that of the previous period (P<0.05).
Conclusions: The following are high risk factors for surgical site infection after CABG: advanced age, history of underlying diseases (hypertension and diabetes), irrational antibiotic use during the perioperative period, operation duration >4 hours, and presence of visitors in the operating room. Medical providers should fully understand these risk factors and optimize the adjustable factors during the perioperative period to minimize the incidence of infections after CABG.